Urology Enrollment Form
The Urology Enrollment Form offers pharmacies a useful form for marketing and advertising their services to prescribers.
With this form, prescribers can quickly and easily fill out the required information.
Once complete, prescribers can submit the prescription to the pharmacy.
The form is interactive.
It contains the following drugs:
- Xgeva, and
- Casodex, and
- Eligard, and
- Lupron, and
- Trelstar, and
- Nilandron, and
- Zoladex, and
Pharmacies fill out the header of the form electronically.
Once entered, the form can be saved so that copies with the header information can be sent to multiple prescribers.
Afterwards, pharmacies can email, hand out, or offer the form online.
Prescribers enter the information for the patient.
Then, the prescriber can fax, email, or mail the form to the pharmacy.
Also, the prescriber can enter the information manually, then scan the form and submit it electronically to the pharmacy.
This form is a great tool to remind prescribers that the pharmacy offers the medication that the patients require.
The document is provided in a zip file format with the PDF and an image file available.